Factors influencing the ownership and utilization of long-lasting insecticidal nets for malaria prevention in Ethiopia

Background Utilization of long-lasting insecticidal nets (LLINs) is regarded as key malaria prevention and control strategy. However, studies have reported a large gap in terms of both ownership and utilization particularly in the sub-Saharan Africa (SSA). With continual efforts to improve the use of LLIN and to progress malaria elimination, examining the factors influencing the ownership and usage of LLIN is of high importance. Therefore, the current study was conducted to examine the level of ownership and use of LLIN along with identification of associated factors at household level. Methods A cross-sectional study was conducted in Mirab Abaya District, Southern Ethiopia in June and July 2014. A total of 540 households, with an estimated 2690 members, were selected in four kebeles of the district known to have high incidence of malaria. Trained data collectors interviewed household heads to collect information on the knowledge, ownership and utilization of LLINs, which was complemented by direct observation on the conditions and use of the nets through house-to-house visit. Bivariate and multivariable logistic regression analyses were used to determine factors associated to LLIN use. Results Of 540 households intended to be included in the survey, 507 responded to the study (94.24% response rate), covering the homes of 2759 people. More than 58% of the households had family size >5 (the regional average), and 60.2% of them had at least one child below the age of 5 years. The ownership of at least one LLIN among households surveyed was 89.9%, and using at least one LLIN during the night prior to the survey among net owners was 85.1% (n = 456). Only 36.7% (186) mentioned at least as the mean of correct scores of all participants for 14 possible malaria symptoms and 32.7% (166) knew at least as the mean of correct scores of all participants for possible preventive methods. Over 30% of nets owned by the households were out of use. After controlling for confounding factors, having two or more sleeping places (adjusted odds ratio [aOR] = 2.58, 95% CI 1.17, 5.73), knowledge that LLIN prevents malaria (aOR = 2.51, 95% CI 1.17, 5.37), the presence of hanging bed nets (aOR = 19.24, 95% CI 9.24, 40.07) and walls of the house plastered or painted >12 months ago (aOR = 0.09, 95% CI 0.01, 0.71) were important predictors of LLIN utilization. Conclusions This study found a higher proportion of LLIN ownership and utilization by households than had previously been found in similar studies in Ethiopia, and in many studies in SSA. However, poor knowledge of the transmission mechanisms and the symptoms of malaria, and vector control measures to prevent malaria were evident. Moderate proportions of nets were found to be out of use or in poor repair. Efforts should be in place to maintain the current rate of utilization of LLIN in the district and improve on the identified gaps in order to support the elimination of malaria

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Visualização e caracterização da rede venosa perioférica: contribuição do garroteamento

Estudo metodológico, com objetivo de identificar quanto o garroteamento pode interferir na visualização e caracterização do calibre das veias periféricas. Fotografias (antebraço/mão) foram avaliadas quanto aos critérios de visualização e calibre, e 19 pares tiveram concordância unânime de três avaliadores para os critérios mencionados. Estas fotos, aos pares (com e sem garrote), foram apresentadas a 61 enfermeiros intensivistas que avaliaram as mudanças entre ambas, utilizando uma escala numérica de 11 pontos (zero= ausência de modificação visual e 10= melhora máxima da visualização). Os dados submetidos à análise fatorial evidenciam que em 63,5% dos fatos houve melhora (>50%) da visualização dos vasos depois de garroteados; as fotos julgadas como sem alteração da visualização retratam veias de difícil visualização e menos calibrosas, em sua maioria. A caracterização prévia da veia quanto ao calibre, visualização e o emprego do critério visual (fotografias) pode ter interferido nas avaliações.Estudio metodológico con objetivo de identificar lo cuanto el garrote puede interferir en la visualización y caracterización del calibre de las venas periféricas. Fotografías (antebrazo/ mano) fueron evaluadas con respecto a los criterios de visualización y calibre, siendo que 19 parejas recibieron concordancia unánime de tres evaluadores para los criterios mencionados. Esas fotos (con y sin garrote) fueron presentadas en parejas a 61 enfermeros especializados en cuidados intensivos, que evaluaron los cambios entre ambas, utilizando una escala numérica de 11 puntos (cero = ausencia de modificación visual y 10 = mejora máxima de la visualización). Los datos sometidos al análisis factorial evidencian que, en el 63,5% de los hechos, mejoró (> 50%) la visualización de los vasos después del garrote; las fotos juzgadas como sin alteración de la visualización muestran una mayoría de venas de difícil visualización y menos calibrosas. La caracterización previa de la vena con respecto al calibre, visualización y el uso del criterio visual (fotografías) pueden haber interferido en las evaluaciones.This methodological research aimed to identify the extent to which tourniquets can interfere in the visualization and characterization of peripheral vein width. Pictures (forearm/ hand) were assessed for visualization and width. Three evaluators of the above mentioned criteria unanimously agreed on 19 picture pairs. These pictures (with and without tourniquets) were presented in pairs to 61 intensive care nurses, who assessed the changes between both, using an 11-point numerical scale (zero = absence of visual alteration and 10 = maximum improvement of visualization). The data submitted to factor analysis evidence that, in 63.5% of the facts, the visualization of the blood vessels improved (>50%) after the use of the tourniquet; the pictures assessed as showing no alteration of the visualization mostly picture veins of difficult visualization and less width. The previous characterization of the vein interfered in terms of caliber and visualization and the use of the visual criterion (pictures) may have interfered in the assessments

Formação do Enfermeiro: desafios para a promoção da saúde La formación del enfermero: retos para la promoción de la salud Nurse training: challenges for health promotion

Estudo qualitativo, descritivo-exploratório, realizado em dois cursos de Enfermagem com o objetivo de analisar os referenciais de promoção da saúde na formação do enfermeiro. Foram entrevistados 19 coordenadores, docentes, estudantes e profissionais de serviços envolvidos na formação do enfermeiro. Os resultados indicam imprecisão conceitual entre promoção da saúde e prevenção de agravos na formação do enfermeiro. As concepções de promoção da saúde reveladas estão associadas a práticas que incidem sobre qualidade de vida sustentada em um conceito amplo e complexo de saúde e que são incipientes nos cenários da atenção à saúde. Conclui-se que a promoção da saúde é tomada como decisão política para mudança na formação do enfermeiro, explicitada nos projetos pedagógicos das instituições cenário do estudo. Entretanto, esta incorporação é incipiente e heterogênea quanto à formulação teórica, indicando a necessidade de ampliação dos espaços de análise conceitual nas relações que proporcionam a produção de saúde e do processo formativo.<br>Estudio cualitativo de tipo descriptivo y exploratorio realizado en dos cursos de enfermería con el objeto de analizar los puntos de referencia de la promoción de la salud en la formación del enfermero. Se entrevistaron a 19 coordinadores, profesores, estudiantes y profesionales de las áreas que participan en la educación y formación del personal de enfermería. Los resultados indican que existe vaguedad conceptual de la promoción de la salud y la prevención de agravamientos en esta formación. El concepto de promoción de la salud está asociado a prácticas de divulgación que se centran en la calidad de vida basada en un concepto amplio y complejo de la salud, incipientes en el ámbito de la asistencia de la salud. Se concluyó que la promoción de la salud se convierte en un instrumento de decisión política que permite realizar cambios en la educación de enfermería puesta de manifiesto en los proyectos de estudio de las instituciones que se enmarcan en esta investigación. Sin embargo, debido a su formulación teórica, esta incorporación es incipiente y heterogénea, confirmando que existe la necesidad de ampliar los espacios para el análisis conceptual dentro del círculo de relaciones que hacen aportes a la producción de la salud y al proceso de formación.<br>This was a descriptive/exploratory study of qualitative character carried out in two Nursing Schools in the State of Minas Gerais. The goal was to analyze the referential of nurses regarding health promotion. Nineteen course coordinators, faculty members, students and professionals of the health services involved in nurse training were interviewed. The results indicate a conceptual imprecision about health promotion and disease prevention. Revealed conceptions of health-promoting practices are associated to practices that affect the quality of life, which lies on a broad and complex concept of health, and are incipient in the current health care scenario. The conclusion is that health promotion is taken as political decision for a change in nurse training, as made explicit in the pedagogical projects of the institutions taking part in the study. However, such incorporation is incipient and heterogeneous in terms of its theoretical formulation, thus indicating the need for widening the space for a conceptual analysis in the relations that allow for the production of health and of a training process